Interns' Experiential Training Perspectives with Pharmacist Prescribing Protocol Development

Elhaum Khobahy, Nkechiamaka Nwosu, Reza Abbasgholizadeh, Mousa Abkhezr*, Valerie U. Oji

Pharmacist intern impressions on prescribing roles and protocol development in the course of their advanced experiential training experiences are described. The objectives of this qualitative study were to: 1) Identify core protocol requirements, 2) Compare/Contrast protocols from U.S. states with extensive pharmacist prescribing protocol history and 3) Design a pharmacist prescribing protocol based on integrated or collaborative care theory. Feedback on prescribing protocol development and pharmacist prescribing roles was gathered from a focus group of pharmacist interns’ activities that included 1) review of the local State Pharmacy law requirements (TX); and 2) comparison of these requirements with six other states or territories (CA, MD, DC, KS, VA, WA) where services are provided by the experiential training site and/or that state has a long history of experience with collaborative drug therapy management; 3) review of local state and out-of-state sample protocols; and 4) key general discussion questions. Prescribing protocols were obtained via Freedom of Information Act (FOIA), known samples, and data on hand. A concise, comprehensive prescribing protocol was developed for application of collaborative chronic care. Core protocol requirements identified were State Pharmacy and Medical Board approval and guidelines; pharmacist and physician licensure; specified prescribing-related and medication-management activities to be delivered by the pharmacists; how medication-management decisions would be made, documented and evaluated. Differences across U.S. states included the issuance of Pharmacist DEA numbers, pharmacist educational requirements, treatment algorithms, state/local guidelines and protocols. Interns' shared experiences led to a perceived underutilization of pharmacists in meeting existing patient health service access needs and addressing medication-related problems. They also identified potential implementation challenges such as time and staffing limitations, provider status recognition, third-party reimbursement, overcoming multidisciplinary stereotypes of pharmacists’ roles, unfamiliarity with pharmacist prescribing as compared to other providers, educational needs for reinforcement on patient diagnoses, laboratory value orders/interpretations, medical record and claims documentation, and interprofessional communication. A positive interest in prescribing roles and protocol development was identified in contributing to patient health service needs. Implementation can be facilitated with an understanding of core protocol requirements, state laws, treatment guidelines and algorithms, potential service implementation challenges, and educational strategies for clinicians, administrators and policy-makers. Educational preparedness should consider the incorporation of these experiences, especially across multidisciplinary settings, to improve collaborative care.